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Concussions and Brain injury

I think it's only a matter of time before everyone is wearing uber-protective helmets. I 'm guessing the process will be driven by lawsuits. I think here in TX high school football they just made a rule that players with a concussion have to sit out for 3 months.

The New York Times

February 5, 2010
Op-Ed Contributor
Will Science Take the Field?
By DEBORAH BLUM

Madison, Wis.

THE warning in The Journal of the American Medical Association is not ambiguous: “There is a very definite brain injury due to single or repeated blows on the head or jaw which cause multiple concussion hemorrhages. ... The condition can no longer be ignored by the medical profession or the public.”

The report in question concerns professional athletes, hardly surprising given the worries expressed during this week’s Super Bowl runup and Congressional hearings into long-term damage caused by football-related concussions. It methodically details the well-publicized problems — loss of coordination, cognitive deficits, uncontrollable rages — that forced the N.F.L. to issue new rules this season limiting players with head injuries from returning to the field.

But what really makes the research and its conclusions so interesting is its timing: it appeared in The Journal of the American Medical Association on Oct. 13, 1928. This raises the question — at least for me — as to why we are announcing the athlete concussion-dementia link as a new, and still somewhat debatable, issue some 80 years later.

It was only in December that the N.F.L. finally conceded publicly that concussions “can lead to long-term problems.” And even that admission was contradicted a few weeks later by one of the league’s longtime brain injury experts, Dr. Ira Casson, who told a Congressional panel that there is not enough “valid, reliable or objective scientific evidence” showing that repeated blows to the head could cause permanent brain damage.

I’d argue that Dr. Casson — and his former friends at the N.F.L. — could have saved themselves and the players a lot of trouble if they’d spent just a little time in the medical archives. That 1928 medical journal paper started a drumbeat of research into head injuries in athletes, continuing throughout the 20th century and intensifying in the last decade. The 82-year-old study, by Dr. Harrison Martland, remains frequently cited by researchers today, partly for its meticulous examination of damaged brains.

The paper is also a terrific reminder of early 20th-century medicine’s down-to-earth approach to research. Martland, the chief medical examiner in Essex County, N.J., began his research by hanging out at boxing matches. He titled the paper “Punch Drunk,” drawing on boxing cant. As he pointed out, boxing fans didn’t hesitate to malign injured boxers, derisively shouting “cuckoo” when obviously brain-damaged fighters shambled into a ring, and referring to those with dementia problems as “slug nutty.”

Martland did autopsies on more than 300 people who had died of head injuries, looking for patterns of brain damage. For his study of boxers, he talked a fight promoter into giving him a list of 23 former fighters he thought could be labeled as definitely punch drunk. Martland was able to track down only 10 of the former athletes, but in those cases, he found the promoter’s diagnosis was on target. Four were in asylums, suffering from dementia. Two had difficulty forming sentences or responding to questions. One was almost blind, two had trouble walking and one had developed symptoms similar to those of Parkinson’s disease.

His colleagues had also begun to realize that a concussive blow to the head could result in injuries that were remarkably slow to heal. An earlier study of repeated concussive blows in more than 100 people warned of possible mental degeneration: “It is no longer possible to say that concussion is essentially a transient state which does not comprise any evidence of structural cerebral injury.”

Martland argued that blows to the head — and the inevitable shaking of the brain that resulted — caused small but cumulative hemorrhages that could lead to scarring called gliosis. Such fibrous scarring is now known to be associated with dementias like Alzheimer’s and diseases like Parkinson’s that affect motor control.

Surveys done in the last few years have found that N.F.L. players are at higher risk of dementias and other mental disorders than the general population. Autopsies of athletes — notably the brains of former N.F.L. players who suffered from profound dementias — consistently found dark clusters of nerve cell proteins, formations more common to elderly Alzheimer’s patients. Similar patterns of damage were recently reported in wrestlers and soccer players. Most of these athletes were dead by age 50.

Doctors investigating these injuries have become effective advocates for player protection in the last few years, and their research has played a critical role in forcing a re-evaluation of game safety standards. At a Congressional hearing on football brain injuries, held in Houston on Monday, legislators accused college athletic officials of ignoring risks and failing to adopt polices that sufficiently protected young players. “It’s money, money, money,” said Representative Steve Cohen, a Tennessee Democrat, “and health care ought to be considered.”

The best response to such statements is: about time. As Harrison Martland’s work reminds us, we can’t pretend that we’ve just discovered that head blows pose a dementia risk. We can take credit for confronting the problem, albeit belatedly. And we can legitimately lay some blame here — if our response has been slow, that’s mostly because the N.F.L., the National Collegiate Athletic Association and their allies have done an outstanding job, up until now, of ignoring and dismissing the medical record. Not everyone is happy about this, of course. Representative Ted Poe, a Texas Republican, complained that “football as we know it” could be destroyed if we move toward greater protectiveness.

I feel safe in diagnosing that comment as slug nutty.

Deborah Blum, a professor of science journalism at the University of Wisconsin, is the author of the forthcoming “Poisoner’s Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York.”

Re: Concussions and Brain injury

Free choice. As professionals they choose a profession that potentially make them multi-generational millionaires and this is a potential risk. Not a single player in college or the NFL can say they are unaware of the risks but they do it because they get something for it that 95% of the rest of the population can't get.

Playing Fantasy Football does not qualify you to be the in the front office or on the coaching staff of the Pittsburgh Steelers. They are professionals and you are not!

Re: Concussions and Brain injury

Originally Posted by Shawn

I believe it to be common sense to use more protection for the head. Seeing some of these former football legends drooling in their soup is just sad.

The more protection you give them the more invincible they believe they are. I'm not sure that there is anything to reduce the risks in the sport of football. An NFL player has been playing probably since he 10 or 11 years old and has received thousands of blows to the head.

The reality is just like anything else in life there are risks and these players know exactly what those risks are at what they could mean to their long term health. If its too big of a risk they should use the full ride they obtained and prepare for a vocation on the university's dime and get on with their life's work. If they need the adrenaline rush of playing in the NFL then they are assuming the risks.

That may sound cold, but it's the truth. When you're young you just simply don't believe that bad things will happen to you 25 years later from what you do now, because, you're healthy. The long term effects are exactly that, long term, and issues from them may not manifest for 20-25 years.

Re: Concussions and Brain injury

I honestly don't know if there have been studies done on the Uber helmets. I would assume some short term studies have been done to promote their use. Until we have 20-30 years of information we just won't know. With that said, more protection for the head makes sense. And if we can reduce the risk why not do so? You couldn't pay me enough millions to be unable to wipe my own asc in my 50's. While I agree these people assume certain risks...many do so from impoverished backgrounds with brains that are not fully formed to make educated decisions. Like you said many of these players started playing very young. I only played 2 years of organized football and suffered a fairly serious neck injury. I still suffer from pain in my neck that I contribute to that blow. Knowing what I know now...no way would I have played. But, I was young, ignorant and had zero insight into the long term ramifications of playing football. I love the sport and respect those that can play at a high level. But, we need to do everything we can to make it a safer sport.

Re: Concussions and Brain injury

Concussions are one reason I wish Ben would learn to get rid of the ball more quickly sometimes. I don't want him to totally change his game, just modify it a bit.

$$$
At the rate he's going, Ben will be drooling in his soup and unable to wipe his own arr$$e
before he hits the age of 40.

Don't just look at the sack totals. Look at the sacks themselves. Many times he's not actually hit hard because a defender has just grabbed onto him and pulled him down before he could get rid of the ball.